抗磷脂酶A2受体抗体与特发性膜性肾病

抗磷脂酶A2受体抗体

与特发性膜性肾病秦卫松南京军区南京总医院全军肾脏病研究所全军肾脏病重点实验室精选课件研究背景研究方法结论精选课件研究背景精选课件BeckJrLH,etal.NEnglJMed2009;361:11WesternBlottingofGlomerularProteinswithSerumfromPatientswithIMN.精选课件GlassockRJ.NEnglJMed,2009,361:81精选课件病例选择特发性膜性肾病：60例肾活检时尿蛋白定量>3.5g/24hr经肾活检病理明确诊断为肾小球膜性病变，光镜观察无内皮或系膜细胞增殖，无内皮下嗜复红物沉积，免疫荧光以IgG、C3为主,C1q阴性；自身抗体检测阴性，无乙肝、丙肝感染、肿瘤病史，无重金属、有机溶剂接触史；特发性膜性肾病治疗后缓解的病例：21例精选课件病例选择V型狼疮性肾炎：20例系统性红斑狼疮、狼疮性肾炎诊断明确；病理上以V型（膜性）病变为主，免疫荧光以颗粒状上皮侧沉积为主，无明显系膜或内皮细胞增殖；肾活检时尿蛋白定量>3.5g/24hr，尿沉渣红细胞<100万/ml。乙肝相关膜性肾病：16例经肾活检病理明确诊断为肾小球膜性病变；乙肝两对半检测显示大三阳和/或HBV-DNA阳性；肾组织乙肝抗原染色阳性(其中HBeAg必须阳性)；经抗病毒治疗后患者尿蛋白部分缓解或完全缓解；肾活检时尿蛋白定量>3.5g/24hr。肿瘤相关膜性肾病：10例肾活检时尿蛋白定量>3.5g/24hr精选课件从肾小球提取蛋白抗原SDS(Non-reduced)转印至硝酸纤维素膜与患者血清孵育（1：25）一抗，二抗，显色实验方法精选课件研究结果精选课件Detectionofanti-PLA2RinidiopathicMN精选课件RecognitionofidiopathicMNserumwithdeglycosylatedPLA2R精选课件Theprevalenceofanti-PLA2RinidiopathicMNandsecondaryMNnAnti-PLA2R%IdiopathicMN604981.7%LupusMN2015.0%HBV-MN1616.3%Tumor-MN10330%TableAnti-PLA2RinChinesepatientswithmembranousnephropathy精选课件Therewasanabsenceofimmunologicdiseaseactivityatthetimewhentheirserumwassampled,despiteproteinuria.Whyremain11IMNpatientsnegative?精选课件Lowtiterofanti-PLA2RinnegativeidiopathicMNLowtiterofanti-PLA2Rexistedin10ofremaining11negativeIMN.PC:aMNserumthatwaspositiveunderstandardconditionsdilutedto1:1000.HC,Healthycontrol,serumfromhealthyadult(1:10).精选课件Associationofanti-PLA2Rwithdiseaseactivity精选课件Anti-PLA2RinIMNandIMNwithcompleteremission81.7%19.0%精选课件结论PLA2R是中国人特发性膜性肾病的重要靶抗原。抗PLA2R抗体可以作为特发性膜性肾病诊断和疗效判断的特异标志物。精选课件致谢刘志红院士DavidJ.SalantLaurenceH.Beck,Jr.

陈朝红曾彩虹左科精选课件IgG4inaglomerulusofapatientwithtumor-MNbutwithoutcirculatinganti-PLA2Rantibodies.BrightIgG4inaglomerulusofapatientwithtumor-MNandcirculatinganti-PLA2Rantibodies.IgG4depositioninglomerulioftumor-MN.精选课件AllthreepatientswithAnti-PLA2R:persistentorrelapseofproteinuriadespiteresectionofthetumor.Inthosepatientswithoutanti-PLA2R:2patients:completeremissionoftheproteinuriaaftertumorresection;3patient